Minor aphthae comprise over 80 percent of all cases. They appear only on the movable, non-keratinized, tissues of the mouth. They are small - less than one centimeter in diameter - and are extremely painful. Minor aphthae are shallow ulcers, covered by a pseudomembrane, and are surrounded by a bright red (erythematous) halo. These oral lesions can appear in groups (crops). Minor aphthous ulcers usually heal without scarring in 7 to 10 days.
Major aphthae make up less than 10 percent of aphthous ulcers. They are bigger (greater than one centimeter in diameter), deeper, and take weeks or months to heal. Major aphthous ulcers often cause scarring.
Herpetiform aphthae appear as multiple, pinpoint, clustered vesicles which appear on unmovable (keratinized) oral tissue. They look like herpetic simplex lesions. Herpetiform aphthae often appear in the back of the mouth, and usually heal within a month.
Common Causes Of Aphthous Ulcers:
Diseases Which Mimic Aphthous Ulcers:
Behcet's syndrome, Reiter's syndrome, inflammatory bowel disease, lupus erythematosus, bullous pemphigoid, and pemphigus vulgaris.
Herpesvirus, cytomegalovirus, varicella, and coxsackievirus.
Syphilis.
Cryptosporidium, mucormycosis, and histoplasmosis.
Cyclic neutropenia, and squamous cell carcinoma.
"Treatment" For Aphthous Ulcers:
Protective ointments and gels, such as Zilactin and Orajel. Diphenhydramine (Benadryl) elixir.
Possibly the most helpful type of treatment. Kenalog in Orabase ointment is applied to dried ulcers four times daily.
To be avoided in children and pregnant women.
Usually reserved for treatment of HIV patients.
Zinc gluconate lozenges, vitamin C, vitamin B complex, and lysine. Mouthwash made of sage and chamomile.
Chlorhexidine gluconate.
How To Prevent Aphthous Ulcers:
A recent article in the British Medical Journal reviewed a number of oral ulcerative conditions.
Scully C, Shotts R: Mouth ulcers and other causes of orofacial soreness and pain. BMJ. 15 July 2000;321:162-65.
Promoting Infant Oral Health
Oral health is a vital component of overall infant health. A partnership between families, dental professionals, and other health professionals is necessary for achieving oral health in infants.
Key elements in promoting infant oral health include:
In spite of the current emphasis on preventive dental health, many children are still affected by dental caries. Caries in baby (primary) teeth is one of the most common health problems affecting young children. In 1996, a national oral health survey found that 38% of children, ages 2 through 9, had dental caries. Caries prevalence in children attending Head Start programs has reached 90% in some group samples. Early childhood caries (ECC) is also a leading cause of operating room admissions for children requiring dental restorations and extractions. Obtaining treatment for caries can be difficult, since according to a 1997 study, almost 4.2 million children in the U.S. were unable to obtain dental care.
Early childhood caries (ECC) is a multifactorial disease which affects children worldwide. It is an aggressive oral disease which can occur in children up to the age of three. It initially affects the upper front teeth, and eventually spreads to the primary first molars. This new term, ECC, encompasses baby bottle tooth decay, nursing caries, rampant caries, sipper cup caries, and caries related to consumption of soft drinks.
The factors affecting the occurrence and severity of ECC include:
Oral hygiene instructions should be provided during the prenatal period. The importance of good oral hygiene during pregnancy cannot be overemphasized. A mother's oral hygiene will affect the birth weight of her baby, as well as her own overall health.
An infant's mouth contains millions of bacteria, including the infectious mutans streptococci. These bacteria are the initiators of the caries disease process. When a parent puts the baby's feeding spoon into his or her mouth, the mutans streptococci bacteria from the parent's mouth will be transferred back to the baby's mouth and infect the baby's teeth. This process can take place as early as eleven months of age. The danger of infecting the infant's teeth is increased when the mother already has the caries disease herself.
In the past, children went to the dentist only after a problem was severe enough to be noticed by a parent. Such an outdated, reactive, approach is no longer appropriate in the age of preventive health, however. The infant oral health visit is now the foundation upon which a lifetime of oral and dental health can be built!
The American Dental Association, the American Academy of General Dentistry, and the American Academy of Pediatric Dentistry all recommend that a child's first oral health visit take place at 12 months of age, or shortly after the eruption of the first baby teeth. This is the ideal time for a dentist to evaluate a child's oral and dental health, as well as to diagnose any problems which may exist.
The goals of the infant oral health visit are to:
During a child's first dental visit, the dentist will:
A caries risk assessment includes evaluating background factors, developing a case history, providing a clinical examination, and possibly taking an oral microbial sample. During the caries risk assessment, the dentist will especially be looking for signs of ECC. One important warning sign of the caries disease is "white spot lesions." These are white, chalky areas on the front teeth, close to the gum line. These decalcifications, caused by acid-producing bacteria, directly precede irreversible loss of tooth structure.
Oral hygiene techniques may be modified depending on a child's age. For small infants, the gums need to be cleaned once or twice a day with a piece of clean gauze. This will help to establish a healthy oral environment for the baby teeth. Infants should be introduced to the toothbrush around the age of one. A baby tooth cleanser should be used up to the age of 2.5 . Around the age of 2.5, a pea-sized drop of children's toothpaste can be applied to the toddler's brush.
Brushing baby teeth can be quite a challenge for new parents. Some infants and toddlers may refuse to let parents brush their teeth. What can parents do? Parents can experiment with various rewards for good behavior during brushing. The initial tooth brushing attempts need to last only 5 seconds or so - and some little reward should be provided immediately thereafter. The time spent brushing the teeth can be gradually increased later on. Using this "rewards technique," parents can follow the first successful attempt at tooth brushing with letting their baby "play with a favorite toy" or "play a favorite game with mom or dad."
The good news is that infant oral health is achievable! By providing a healthy diet, minimizing the consumption of sweets, cleaning a child's teeth twice a day, and getting early dental examinations, a child can have a happy, healthy smile.
An article in American Family Physician reviews the principles of infant oral health.
Sanchez OM, Childers NK: Anticipatory guidance in infant oral health: rationale and recommendations. Am Fam Physician 2000; 61:115-20, 123-4.
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